<?php use_helper('Validation') ?>
<style type="text/css">
.form_error
{
  display: inline;
}
</style>
<?php if ($sf_request->hasErrors()): ?>
<h1 class="error">Verifique los siguientes errores y envie de nuevo el formulario:</h1>
<?php endif; ?>
<?php echo form_tag("sfDenariiPayment/requestPayment") ?>
<?php
   $card_list = array('VISA' => 'VISA', 'MasterCard' => 'MasterCard', 'AmericanExpress' => 'American Express', 'Discover' => 'Discover','Unknown'=>'Unknown');
  // echo select_tag('cc_type', options_for_select($card_list, 'AMEX', array('include_custom' => '-- Select Credit Card Type --')));
?>
<table>
  <tr><td>CreditCardType:&nbsp;</td><td><?php echo select_tag('credit_card_type', options_for_select($card_list, $sf_params->get('credit_card_type'))) ?></td></tr>
  <tr><td>PAN:&nbsp;</td><td><?php echo input_tag('PAN',$sf_params->get('PAN')) ?>&nbsp;<?php echo form_error('PAN') ?></td></tr>
  <tr><td>PANEXPDate:&nbsp;</td><td><?php echo input_date_tag('PAN_exp_date',$sf_params->get('PAN_exp_date'),array('rich'=>false)) ?>&nbsp;<?php echo form_error('PAN_exp_date') ?></td></tr>
  <tr><td>E-mail:&nbsp;</td><td><?php echo input_tag('email',$sf_params->get('email')) ?>&nbsp;<?php echo form_error('email') ?></td></tr>
  <tr><td>CVV2:&nbsp;</td><td><?php echo input_tag('CVV2',$sf_params->get('CVV2')) ?>&nbsp;<?php echo form_error('CVV2') ?></td></tr>
  <tr><td>First Name:&nbsp;</td><td><?php echo input_tag('first_name',$sf_params->get('first_name')) ?>&nbsp;<?php echo form_error('first_name') ?></td></tr>
  <tr><td>Last Name:&nbsp;</td><td><?php echo input_tag('last_name',$sf_params->get('last_name')) ?>&nbsp;<?php echo form_error('last_name') ?></td></tr>
  <tr><td>AVS Address:&nbsp;</td><td><?php echo input_tag('AVS_address',$sf_params->get('AVS_address')) ?>&nbsp;<?php echo form_error('AVS_address') ?></td></tr>
  <tr><td>City:&nbsp;</td><td><?php echo input_tag('city',$sf_params->get('city')) ?>&nbsp;<?php echo form_error('city') ?></td></tr>
  <tr><td>State:&nbsp;</td><td><?php echo input_tag('state',$sf_params->get('state')) ?>&nbsp;<?php echo form_error('state') ?></td></tr>
  <tr><td>Country:&nbsp;</td><td><?php echo select_country_tag('country',$sf_params->get('country')) ?>&nbsp;<?php echo form_error('country') ?></td></tr>
  <tr><td>Phone:&nbsp;</td><td><?php echo input_tag('phone',$sf_params->get('phone')) ?>&nbsp;<?php echo form_error('phone') ?></td></tr>
  <tr><td>AVS Zip Code:&nbsp;</td><td><?php echo input_tag('AVS_zip_code',$sf_params->get('AVS_zip_code')) ?>&nbsp;<?php echo form_error('AVS_zip_code') ?></td></tr>
</table>                  
<?php echo submit_tag('Enviar') ?>
</form>
